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Your feeding tube options

A number of options exist for enteral feeding tubes. Factors to consider when choosing the most appropriate tube include the animal's nutritional status, its ability to tolerate anesthesia, the length of time the animal is expected to require nutritional support, the function of the animal's gastrointestinal tract (and using as much of the gastrointestinal tract as possible), available hospital facilities, the cost, and your comfort level with different techniques for tube placement. Detailed information on placing these feeding tubes is described elsewhere.1-3

Nasoesophageal and nasogastric tubes

Nasoesophageal (NE) and nasogastric (NG) tubes are typically 3.5- to 8-Fr feeding tubes (red rubber, silicone, or polyurethane). Light sedation may be required; however, applying a local topical anesthetic agent (e.g. ophthalmic proparacaine hydrochloride) to the nares is usually sufficient for tube placement in most animals.

1. A dog with an NG tube. The dog was anorectic because of acute kidney injury due to leptospirosis, so enteral feeding was used to provide nutrition and to help maintain gastrointestinal function. An E-collar was used to reduce the risk of early tube removal.

NE tubes terminate in the distal third of the esophagus, whereas NG tubes reach the stomach. There is some thought that NG tubes may interfere with the lower esophageal sphincter and contribute to gastric reflux; however, this relationship has not been proved. Placing an NG tube may be preferable if measurement or removal of residual gastric fluid is desirable or if occasional vomiting is possible. Secure the tube to the nasal planum by using sutures, skin staples, or glue, and perform radiography to confirm proper placement. Elizabethan collars are usually required to prevent early tube removal (Figure 1).

Potential reasons to avoid placing an NE or NG tube include severe thrombocyctopenia, underlying coagulopathy (epistaxis may occur), or dyspnea since one nostril will be occluded. NE and NG tubes require a liquid diet and are best used for short-term (< five days) nutritional support.

Esophagostomy tubes

Esophagostomy (E) tubes are typically > 14-Fr feeding tubes (red rubber, silicone, or polyurethane). Red rubber tubes are less expensive than tubes made of other material but do not last as long and may be less comfortable for the patient. However, anecdotally, tubes made of other material can be harder to place and may be more likely to displace if the animal vomits. For large dogs (> 55.1 lb [25 kg]), long E tubes are available commercially, or stallion urinary catheters can be used.

2. A cat with an oral squamous cell carcinoma with an E tube in place. The tube was secured with a purse-string and finger-trap suture pattern.

General anesthesia is required when placing E tubes. Although commercial tube placement devices are available, we prefer curved forceps for placement. E tubes should terminate in the distal third of the esophagus, and proper placement should be confirmed with radiography. Secure tubes with a purse-string and finger-trap suture pattern (Figure 2).

E tubes may be maintained for weeks to months if necessary and are good choices for long-term nutritional support. Liquid enteral diets, critical care diets, or canned food that has been liquefied by using a blender can be fed through an E tube. Choosing an appropriate diet will depend on the patient's underlying medical condition.